CREDENTIALING PROCESS – Detailed overview – TAT for top payers

CREDENTIALING PROCESS FOR NEW PHYSICIANS Overview New physicians/providers must credential themselves, i.e., enroll and attest with the Payer’s network and authorized to provide services to patients who are members of the Payer’s plans. The credentialing process...

Top reason for delay in Credentialing process

Source of Delays in the Credentialing Process The credentialing process may get further delayed due to few primary causes. They are as follows: Poor response or planning: Many times the response from new physicians or even credentialed physicians for our requests of...

CPT denied for performed in calendar month or year

Reimbursement Guidelines Time Span Codes UnitedHealthcare will reimburse a CPT or HCPCS Level II codethat specifies a time periodfor which it should be reported (e.g., weekly, monthly), once during that timeperiod. The time period is based on sourcing from the AMA or...

CPT CODE 93922, 93923, 93924 , 93925 AND 93926

CPT Code Description 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (e.g. for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler...

Hypertension ICD overview – I10, I11 , I11.0 – I11.9

Essential (primary) hypertension: I10 In ICD-9, essential hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-10 uses only a single code for individuals who meet criteria for hypertension and do not have comorbid heart or kidney...

CO : Contractual Obligations denial code list

MCR – 835 Denial Code List CO : Contractual Obligations – Denial based on the contract and as per the fee schedule amount. CO should be sent if the adjustment is related to the contracted and/or negotiated rate Provider’s charge either exceeded contracted...

Medicaid denial reason code Full list

Medicaid Claim Denial Codes 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. 5 The procedure code/bill type is inconsistent with the place of service. 6 The...

BCBS insurance full denial code list

BCBS denial code list BCBS insurance denial codes differ state to state and we could not refer one state denial code to other denial. Here we have list some of the state and Use Ctrl + F to find the code and exact reason for that codes. If the reason code not listed...

PR – Patient responsibility denial code full list

PR – Patient Responsibility denial code list MCR – 835 Denial Code List PR – Patient Responsibility – We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB. Same denial code...

Medicare denial – OA – Other adjustment denial code full list

Medicare denial codes – OA : Other adjustments, CARC and RARC list Medicare contractors are permitted to use the following group codes: CO Contractual Obligation (provider is financially liable);CR Correction and Reversal (no financial liability);OA Other...